Community health services in European literature: A systematic review of their features, outcomes, and nursing contribution to care

• Published in: International nursing review 2024-12, Vol.71 (4), p.716-728
• Main Authors: Caponnetto, Valeria, Dante, Angelo, El Aoufy, Khadija, Melis, Maria Ramona, Ottonello, Giulia, Napolitano, Francesca, Ferraiuolo, Fabio, Camero, Francesco, Cuoco, Angela, Erba, Ilaria, Rasero, Laura, Sasso, Loredana, Bagnasco, Annamaria, Alvaro, Rosaria, Manara, Duilio Fiorenzo, Rocco, Gennaro, Zega, Maurizio, Cicolini, Giancarlo, Mazzoleni, Beatrice, Lancia, Loreto
• Format: Article
• Language: English
• Subjects: Clinical outcomes; Community care services; Community health care; Community health services; Community Health Services - organization & administration; Community nursing; Emergency services; Europe; European literature; Frail; Health care policy; Health services; Health status; Heart failure; home care services; Humans; Interdisciplinary aspects; Literature reviews; Management development programmes; Needs; Nurse's Role; Nurses; Nursing; Nursing care; nursing determinants; nursing homes; Older children; Older people; Organizational models; Organizational structure; patient outcomes; primary care; Quantitative analysis; remote health; Staffing; Systematic Review; transitional care; Treatment compliance; Work environment; Workforce planning; Workloads
• ISSN: 0020-8132; 1466-7657; 1466-7657
• DOI: 10.1111/inr.13033

Background To meet the population's needs, community care should be customized and continuous, adequately equipped, and monitored. Introduction Considering their fragmented and heterogeneous nature, a summary of community healthcare services described in European literature is needed. The aim of this study was to summarize their organizational models, outcomes, nursing contribution to care, and nursing‐related determinants of outcomes. Methods A systematic review was performed by searching PubMed, CINAHL, Scopus, and Embase in October 2022 and October 2023 (for updated results). Quantitative studies investigating the effects of community care, including nursing contribution, on patient outcomes were included and summarized. Reporting followed the PRISMA checklist. The review protocol was registered on PROSPERO (CRD42022383856). Results Twenty‐three studies describing six types of community care services were included, which are heterogeneous in terms of target population, country, interventions, organizational characteristics, and investigated outcomes. Heterogeneous services’ effects were observed for access to emergency services, satisfaction, and compliance with treatment. Services revealed a potential to reduce rehospitalizations of people with long‐term conditions, frail or older persons, children, and heart failure patients. Models are mainly multidisciplinary and, although staffing and workload may also have an impact on provided care, this was not enough investigated. Discussion Community health services described in European literature in the last decade are in line with population needs and suggest different suitable models and settings according to different care needs. Community care should be strengthened in health systems, although the influence of staffing, workload, and work environment on nursing care should be investigated by developing new management models. Conclusions and implications for health policy Community care models are heterogeneous across Europe, and the optimum organizational structure is not clear yet. Future policies should consider the impact of community care on both health and economic outcomes and enhance nursing contributions to care.